Fran Lowry

April 14, 2015

MIAMI — Feelings of shame may increase the risk for suicide in people with symptoms of social anxiety, according to new research.

"Shame is actually a mediator for social anxiety and suicide risk," lead researcher Danielle M. Morabito, PhD, from the University of Miami, Coral Gables, Florida, told Medscape Medical News.

"Shame is the reason why social anxiety leads to feelings of increased perceived burdensomeness, the feeling that one is a burden to family and friends and that they would be better off without you," Dr Morabito said.

"We feel that the results of our research indicate that feelings of shame should be looked for in suicide risk assessments," she added.

The study was presented here at the Anxiety and Depression Association (ADAA) Conference 2015.

Important Prevention Target

Research has demonstrated links between social anxiety symptoms, shame, and risk factors for suicide, but there has been no systematic examination of the relationship between these constructs, Dr Morabito noted.

In the current study, the investigators examined the potential associations between symptoms of social anxiety and feelings of shame, including thwarted belongingness, in which a person feels that they do not have enough social connections or that the social connections they do have are not very strong, and perceived burdensomeness.

The 259 participants responded to an online survey through Amazon.com's Mechanical Turk.

They completed the Social Interaction Anxiety Scale (SIAS), the Experiences of Shame Scale (ESS), and the 12-item Interpersonal Needs Questionnaire as part of a broader study on emotional experiences.

Dr Danielle Morabito

The survey found that all associations between social anxiety, interpersonal suicide risk, and shame were highly significant (P < .001).

"Higher SIAS scores were associated with greater thwarted belongingness and perceived burdensomeness and were also associated with higher levels of shame, including bodily, behavioral, and characterological shame, on the ESS, and higher ESS scores were associated with higher levels of interpersonal suicide risk," Dr Morabito said.

"Shame may represent an important target of treatment for individuals with social anxiety, and it may also be important to consider social anxiety and shame when conducting suicide risk assessments," she said.

Key Risk Component

Commenting on the study for Medscape Medical News, Kerry Ressler, MD, PhD, from Emory University, Atlanta, Georgia, said: "This is an interesting, moderately powered, and potentially significant finding. These data suggest that self-assessment of shame-related symptoms are a key component of risk for suicide."

Dr Kerry Ressler

"These data suggest that clinically focusing on self-acceptance, decreasing shame, and decreasing social anxiety may all be critical parameters to treatment and suicide prevention," Dr Ressler, who was not part of the study, added.

Dr Morabito and Dr Ressler report no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) Conference 2015. Abstract 184. Presented April 10, 2015.

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